Cultural Drivers of Health-Seeking Behaviours Among Black Sub-Saharan Africans Living with Type 2 Diabetes: Ethnographic Perspectives

People of Black sub-Saharan African (BsSA) origin in the UK have increased susceptibility of being diagnosed with type 2 diabetes compared to the general White population. Self-management is central in halting the progression of diabetes-related complications. However, little is known about the cultural factors influencing self-management behaviours among this population. This ethnographic study explores this disjuncture, which results from the gap between the biomedical model of treatment and people’s subjective practice of healing based on narratives of people living with type 2 diabetes among the BsSA communities. Care for people with type 2 diabetes needs to incorporate an understanding of broader socio-cultural perspectives of disease management.

Analysis of data was informed by the PEN-3 public health cultural model which moves beyond individualistic and bio-medical explanations of diabetes. This theory posits a multifaceted causal model in which cultural beliefs and identity operate in recognised illness experience, outcome expectations, and perceived facilitators in self-management behaviours and well-being. The study findings present the interface between these behaviours and health-seeking practices. Cultural belief was found to be of paramount importance in self-management of diabetes. Culturally appropriate advice and services from healthcare providers and the significance of narratives of people in managing diabetes, in particular for informing ways of optimising healthcare services among BsSA communities are critical. A broad interpretation of individuals’ narratives of diabetes, their social and cultural context and their relationships with healthcare providers contributes to the debate about power relations between providers and users of healthcare. People's beliefs and experiences in their collective ability to achieve behavioural change play a fundamental role in the policy and public health perspective to health promotion and disease prevention.